| NPI | 1609394253 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR PA189209) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 4113-23) |
| Enumeration Date | 2017-09-05 |
| Last Update Date | 2021-04-21 |